Putting patients first can save our health system

Ontario’s Patients First Act offers an opportunity for a real transformation in the way we deliver services.

Home care can help older people stay in their own homes as long as possible. (Dreamstime)

By Kapil KhimdasDanyaal Raza

Mon., Aug. 7, 2017

It’s no secret: Ontario is getting older. The number of seniors in our province has been steadily increasing and will double over the next 20 years. Including factors like increased use of health services and evolving technology, this will result in a substantial increase in demand across the health system. Those services will cost money.

In just the continuing care sector (including home care, rehab facilities and long-term care homes) public spending will need to increase by $16 billion. That doesn’t include an increase in private spending of another $10 billion.

Our provincial government’s response to this challenge is the Patients First Act, which is currently being put into action. Patients First is a structural reorganization of agencies in the community health system, empowering local health authorities with more responsibility for primary and home health care delivery.

How exactly will this help us take care of double the number of seniors by 2037?

It’s not entirely clear — at least not yet. There is a risk that this reorganization with a friendly name will just shuffle activity from one branch of government to another.

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But there’s opportunity for a real transformation in the way we deliver services. Taking care of more seniors does not have to be more expensive. That’s the potential of Patients First: to reorganize our health system to treat patients before they become patients and to organize care around cost-effective, community-based care instead of relying on the traditional, expensive, hospital environment.

There are three major ways that Local Health Integration Networks (LHINs) can use their new responsibilities to drive change.

First, improve what they’re doing already. We know better community and primary care can avoid expensive hospital admissions. Yet our health system is still largely organized around hospitals, while the illnesses that affect most patients are chronic and can be better managed in the community.

That’s where LHINs should start to shift the focus of care. For example, why not give hospitals the means and funding to organize their own home care and measure their performance on reducing admissions?

The second is by prioritizing populations according to those who can benefit most. We know that our most socio-economically challenged communities have the highest rates of illness and the lowest levels of primary care support. LHINs should focus support on these areas. For example, why not actively direct home care and primary care funding towards these communities?

The third is to improve population health and disease prevention. Our rates of preventable illness are higher than they could be. What if we focused on reducing them?

LHINs can also cement a population health approach to all services in their communities. For example, LHINs could collaborate with primary care practices to measure and monitor overall health status and give family doctors the financial flexibility to prescribe any kind of support — like housing or income supports — that result in healthier patients and communities.

In shifting our focus towards prevention and community care, we will need to be very mindful of Canada’s promise of universal care for all. The Canada Health Act is what guarantees that all hospital-based services must be publicly funded and accessible to all. But in the community, the act only does this for physician services. This shift to preventative and community-based care needs to be undertaken with a promise of universal access if we wish to create a system that will effectively serve a graying population.

Patients First could be an incredible moment for health leaders to dramatically reshape how health care is delivered in Ontario — to truly realize the government’s vision of making Ontario the “healthiest place in North America to grow up, and to grow old.”

Kapil Khimdas has worked in senior management roles in health systems in Canada and the United Kingdom.

Danyaal Raza is an expert adviser with EvidenceNetwork.ca, family physician at St. Michael’s Hospital and assistant professor with the Department of Community and Family Medicine at the University of Toronto.